September is National Suicide Prevention Month. Suicide is among the leading cause of death in the United States — on average, 132 Americans die by suicide each day and 1.4 million attempted suicide in 2019, according to the CDC. Approximately 90 percent of people who die by suicide and who have been studied through psychological autopsies were shown to have a psychiatric illness at the time of their death.
Suicide is the ultimate individualized experience, however, there are some common risk factors that studies have shown are experienced by an individual early in the suicide process. Risk factors, or early warning signs, are conditions that make people vulnerable to viewing suicide as a problem-solving strategy. Risk factors can be grouped into three categories: Psychiatric disorders, social stressors, and psychological vulnerabilities.
Dysthymia: A subtle, chronic, depressive disorder where patients can present as tired, lethargic, low energy, or display low enthusiasm or passion about life. They can be highly functional people who might not seek treatment because they think “this is how I always feel” and may self-medicate with alcohol. Dysthymia can become correlated to hopelessness and suicide is a direct result of hopelessness.
Major Depressive Disorder (MDD), severe, with Psychotic Features: MDD is a disabling depression that can increase risk of suicide, however, the specifiers can be highly correlated (or not causal) with completed suicide.
Bipolar Disorders: Bipolar II carries the highest risk for suicide. Many individuals take their lives, not in the depths of their depression, but as they are improving due to small increases in energy — enough energy to take their lives. Bipolar I has carried a low risk for suicide due to psychotic levels of grandiosity during a manic episode. During a grandiose manic phase, a person believes they are too important and therefore it can act as a suicide preventative.
Generalized Anxiety Disorder: These individuals can be productive or perfectionistic as they attend to every detail or manage anxiety symptoms by constantly being busy. Since these individuals have trouble relaxing, they are constantly worried, busy, and have difficulty tolerating calm. In times of intense anxiety, they can drive their support systems away and may self-medicate with marijuana.
Post-Traumatic Stress Disorder (PTSD) and Borderline Personality Disorder (BPD): Both are significant risk factors for suicide and self-mutilation. PTSD is usually comorbid with substance use disorders, eating disorders, somatization disorders, and dissociative disorders, which can increase the risk of suicide. PTSD is often seen in people diagnosed with Borderline Personality Disorder and a history of chronic abuse. Those with BPD are at high risk for self-mutilation and suicide.
Schizophrenia: The majority of this population will commit suicide during a depressive episode, not a psychotic episode.
Substance-Related Disorders: The risk of suicide is significant due to their vulnerability or hopelessness. The history of drug or substance use has resulted in significant losses in relationships, vocational, and occupational opportunities, poor physical health, involvement in the legal system, significant damage to self-esteem, lessened autonomy, and high levels of self-hatred.
Suicide never occurs outside of the context of major social stressors.
For adults, social stressors are “issues of loss”:
- Loss of primary relationships
- Risk of isolation or rejection
- Survivors of suicide
- Loss of health
- Loss of social definition
- Loss of occupational definition (Occupational definition is not job loss. People who define themselves by what they do for a living and whose entire self-concept is formed through performance can experience intolerable damage to their self-image when that performance is lost.)
Adolescents will experience similar losses to adults, but they also have their own stressors that will impact them in different ways and at different levels of intensity than adults:
- Substance-related disorders for self-management
- Victim of bullying
- Acculturation issues
- Academic Performance Anxiety
- Family Discord
- Impulsivity with access to firearms
Children are vulnerable to:
- A premature death
- Loss of a loved object
All suicides are marked by a lifelong pattern of weak or faulty coping and problem-solving skills such as:
- Performance Anxiety: Perfectionistic tendencies that are reflective of the need to be loved and represent a sense that “I can only be loved if I am perfect.”
- Emotional Constriction: When a person has been invalidated emotionally and therefore becomes constricted, it makes it difficult to maintain intimate relationships.
- The Defenseless Personality: This is a person that believes they are not capable of solving the problems life has presented and they are unable to effectively manage the unbearable level of pain they are now feeling.
TREATMENT AND THERAPIES
Cognitive Behavioral Therapy (CBT): A type of therapy that can be used to help people learn effective ways to cope with stressful situations.
Dialectical Behavioral Therapy (DBT): Can help a person recognize when their feelings or actions are disruptive or unhealthy and teach the individual skills that can help them cope more effectively with upsetting situations.
Medication: Individuals can benefit from both medications and psychosocial interventions.
Collaborative Care: A team-based approach to develop a treatment plan
Safety Planning: People can work with a caregiver to develop a plan that describes ways to limit access to lethal means such as firearms, pills, or poisons.
As an HR team member, employees in crisis may reach out to you for help. The resources below can be utilized in a crisis situation when someone with suicidal thoughts needs immediate help:
National Suicide Prevention Lifeline: Provides 24-hour, toll-free, and confidential support to anyone in suicidal crisis or emotional distress. Call 1-800-273-TALK (8255) to connect with a skilled, trained counselor at a crisis center nearby. Support is available in English and Spanish and via live chat.
Disaster Distress Hotline: People affected by any disaster or tragedy can call this helpline, sponsored by SAMHSA, to receive immediate counseling. Call 1-800-985-5990 to connect with a trained professional from the closest crisis counseling center within the network.
Veterans Crisis Line: This helpline is a free, confidential resource for Veterans of all ages and circumstances. Call 1-800-273-8255, press “1”; text 838255; or chat online to connect with 24/7 support.
Crisis Text Line: Text HELLO to 741741 for free and confidential support 24 hours a day throughout the U.S.
For additional resources that aren’t emergent or critical, you can rely on the references below:
- National Action Alliance for Suicide Prevention
- NIMH Multimedia on Suicide Prevention
- NIMH Suicide Prevention
- Take 5 To Save Lives
- As always, you can reach out to your Care Team for support by sending a message using the Eden app
Authored by Ashley Pearson, LMHC, NCC, CCMHC